Editors' Introduction Psychotropic Medications and Psychoanalysis an Alloyed Analysis or Still Pure Gold?

Ever since Freud discarded hypnosis and suggestion, psychoanalysts have been careful not to reintroduce these elements into the analytic situation. American analysts may have been particularly on guard, since Freud predicted that Americans would be inclined to “alloy the pure gold of psychoanalysis with suggestion.” Psychoanalytic

technique thus aimed at approximating an ideal framework of neutrality in which the patient would free associate and the analyst interpret. While there might be changes in states of consciousness, these would be attributable solely to the analytic setting and the responses it evoked. Most analysts would very likely agree that these remain the optimal conditions for analysis in that the patient's drives, affects, and transference remain unaltered by any activity of the analyst other than his interpretations. Kurt Eissler introduced the term parameters to describe the range of measures apart from interpretation that could be introduced without severely compromising the analysis. Psychotropic medications, which were starting to appear around the time of Eissler's contribution, were initially thought to be outside the range of acceptable parameters. It was assumed that drugs so altered the patient's state of consciousness, perception, and expression of drive and affect, as to hopelessly compromise the analytic process. Further, it was thought that administration of drugs by the analyst, whether directly or indirectly via a third party, would irreversibly distort the transference. This was accepted as a given, foreclosing debate for many years. Those few analysts who employed medications were thought to be outside the mainstream. Only in recent years has serious clinical inquiry and debate begun. In the interests of spurring this debate, the Editors are pleased to present the minutes of a Panel Discussion on psychotropic medications and psychoanalysis recently held at the New York Psychoanalytic Institute. Both sides of the debate are clearly r